هزینه یابی مبتنی بر فعالیت برای افزایش کارآیی
Abstract
Introduction
Methods
Results
Discussion
Take-Home Points
Acknowledgments
Additional Resources
References
Abstract
Purpose: In this study, we used time-driven activity-based costing to increase efficiency in our ultrasound-guided breast biopsy practice by understanding costs associated with this procedure. Methods: We assembled a multidisciplinary team of all relevant stakeholders involved in ultrasound-guided breast biopsies, including a radiologist, a lead technologist, a clinical assistant, a licensed practical nurse, and a procedural support assistant. The team mapped each step in an ultrasound-guided breast biopsy from the time of scheduling a biopsy to patient checkout. We completed on average 20 time observations of each step involved in these biopsies from a provider’s perspective. Using capacity cost rate, we calculated the cost of all resources including personnel, supply, room, and equipment costs. Several costly steps were identified in the process, which led to the intervention of changing our overlapping biopsy times to staggered biopsy times. Time observations for each step and cost calculations were repeated postintervention. Results: Our postintervention data showed that the total time spent by the radiologist in an ultrasound breast biopsy decreased by 28%, accounting for 56% of the total cost in comparison with 63% pre-intervention. The radiologist’s wait time decreased by 38%, accounting for 28% of the total cost in comparison with 35% pre-intervention. Our total cost of the procedure decreased by 20%, and the personnel cost decreased by 25%. Conclusions: Time-driven activity-based costing is a practical way to calculate costs and identify non-value-added steps, which can foster strategies to improve efficiency and minimize waste.
Introduction
With increasing health care costs and evolving payment models, it is more critical than ever that medical providers maximize value by increasing efficiency and decreasing costs. Although value is difficult to define in health care, Porter’s widely cited definition of value is outcomes achieved relative to costs (outcomes/cost) [1]. To enhance value, one must improve outcomes or decrease cost. Although there has been a significant focus on improving patient outcomes in the recent past through regulatory and financial incentive models, there has been scant emphasis on decreasing cost. To decrease cost, one must be able to evaluate the true cost of a medical process or procedure. Calculating the cost of a medical process or procedure is challenging because various shareholders in the health care arena often define costs differently. Health care policy makers may refer to cost as the money paid to providers for medical services, and providers may define their costs by their reimbursement, but these are not necessarily the costs incurred by the health care system for a medical process or procedure [2,3]. Not knowing true costs prevents one from truly decreasing costs, which can have substantial negative downstream consequences such as the inability to adequately negotiate reimbursement in a bundled payment model.